Basic Information
| Provider Information | |||||||||
| NPI: | 1144549692 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIWARI | ||||||||
| FirstName: | TATULYA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 E MEDICAL CENTER DRIVE | ||||||||
| Address2: | UH B1D530 | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7346474144 | ||||||||
| FaxNumber: | 7346151276 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DR #B1F510K | ||||||||
| Address2: | RAD: DIAGNOSTIC RADIOLOGY | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349364338 | ||||||||
| FaxNumber: | 7346153506 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2010 | ||||||||
| LastUpdateDate: | 10/23/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0204X | 4301106929 | MI | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 390200000X | 11015479A | IN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | 0116023309 | VA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.